Ultrasonographic anatomy of the long thoracic nerve: A reappraisal using high frequency (24-MHz) probe.

PURPOSE: The purpose of this study was to analyze the potential of ultrasound with a high frequency probe (24-MHz) in the assessment of the long thoracic nerve (LTN) and describe ultrasonographic landmarks that can be used for standardization. MATERIAL AND METHODS: Ultrasonography analysis of the LTN was done on 2 LTNs in a cadaver specimen and then on 30 LTNs in 15 healthy volunteers (12 men, 3 women; mean age, 28.8±3.8 [SD] years; age range: 24-39 years) by two independent radiologists (R1 and R2) using a 24-MHz probe. Interrater agreement was assessed using Kappa test (K) and intraclass correlation coefficient (ICC). RESULTS: In the cadaver, dissection confirmed that the India ink was injected near the LTN in the middle scalene muscle. In volunteers, visibility of the LTN above the clavicle was highly reproducible for the branches arising from C5 (R1: 87% [26/30]; R2: 90% [27/30]; K=0.83) and from C6 (R1: 100% [30/30]; R2: 97% [29/30]; K=0.94). Where the nerve emerged from the middle scalene muscle, the mean diameter was 0.85±0.24 (SD) mm (range: 0.4-1.6mm) for R1 and 0.9±0.23 (SD) mm (range: 0.4-1.7mm) for R2 (ICC: 0.96; 95% CI: 0.92-0.98%). Along the thoracic wall, where LTN run along the lateral thoracic artery, the mean diameter was 0.83±0.19 (SD) mm (range: 0.5-1.27mm) for R1 and 0.89±0.21 (SD) mm (range: 0.6-1.2mm) for R2 (ICC: 0.86; 95% CI: 0.72-0.93%). CONCLUSION: The LTN can be analyzed with ultrasound using high-frequency probe by using the C5 and C6 roots, the middle scalene muscle above the clavicle and the lateral thoracic artery on the chest wall as landmarks.

Ultrasonography study of the suprascapular nerve.

PURPOSE: The aim of the study was to evaluate the assessability of the suprascapular nerve (SSN) by ultrasonography in cadavers and healthy volunteers. MATERIALS AND METHODS: With ultrasonography guidance, needles were placed at origin of the SSN of four cadavers and evaluated by dissection. Two blinded radiologists performed 60 ultrasonography scans in 30 healthy volunteers to study the entire SSN at five anatomical landmarks. RESULTS: Dissection revealed that the needles were correctly located at the nerve's origin. There were no significant differences between the two radiologists' measurements of nerve size and depth. The interobserver correlation for the description of the nerve at the five predefined anatomical landmarks was very good (ICC=0.7-1). CONCLUSION: Five anatomical landmarks were used to analyze the SSN with ultrasonography. Its supraclavicular portion was easier to describe than its scapular portion; a segment of the SSN was not visible between these two portions.

Bone abnormalities of the knee: MRI features.

The knee is one of the most studied anatomical structures by magnetic resonance imaging (MRI). Bone abnormalities are very frequently detected, whether or not related to the symptoms for which imaging was indicated. The aim of this pictorial study is to review the most commonly observed bone abnormalities of the knee, bearing in mind that the interpretation of MR images should always take into consideration both clinical and laboratory data, as well as the results of conventional X-ray imaging.

Tumors and pseudotumors of the hand: The role of imaging.

The assessment of a swelling or mass of the wrist or the hand is commonly performed by radiologists. Because cysts on the wrist are, by far, the most frequent pathology. Diagnosis is usually based on standard radiography and ultrasound alone. Additional imaging techniques, and in particular MR imaging, are necessary to assess tumors, although malignant tumors of the hand are rare. Some benign cysts have pathognomonic characteristics visible on imaging. By understanding them, treatment planning may be improved.

Ultrasonography of the brachial plexus, normal appearance and practical applications.

Ultrasound examination of the brachial plexus, although at first sight difficult, is perfectly feasible with fairly rapid practical and theoretical training. The roots are accurately identified due to the shape (a single tubercle) of the transverse process of C7 in the paravertebral space, and the superficial position of C5 in the interscalene groove. The téléphérique technique allows the roots, trunks and cords to be followed easily into the supraclavicular fossa. In just a few years, ultrasound imaging of the plexus has become a routine anesthesia examination for guiding nerve blocks. In trained hands, it also provides information in thoracic outlet syndromes, traumatic conditions (particularly for postganglionic lesions) and tumoral diseases. Even if MRI remains the standard examination in these indications, ultrasound, with its higher definition and dynamic character, is an excellent additional method which is still under-exploited.

Limb infections in children and adults.

Infections of the bone and soft tissue of the limbs need to be diagnosed and treated urgently regardless of the patient's age. Clinical features are often non-specific. MRI and, in some cases, sonography investigations lead to early diagnosis and appropriate management. Computed tomography has limited value. Needle aspiration and biopsy need not be routine. In children, anatomical particularities explain the different morphological manifestations, which vary with age. It is important to both know when to propose the diagnosis of infection, so that appropriate imaging investigations are carried out, and to be aware of the symptomatology of limb infections in children and adults and understand the differential diagnoses for each age group. Clinicians should also be aware of the specific characteristics in children.

[Cross-sectional imaging of peripheral involvement in psoriatic arthritis]. / Nouvelle imagerie des atteintes périphériques du rhumatisme psoriasique.

The purpose of this article is to: 1) describe the main plain film, ultrasound and MR imaging features of peripheral involvement in psoriatic arthritis, 2) describe the advantages of ultrasound and MRI at the early stages of the disease; 3) describe how to use MRI and ultrasound in order to assess response to tumor necrosis factor-alpha blocker therapy.

[Pelvic and spinal MR follow-up of multiple myeloma patients after high-dose chemotherapy and autologous peripheral blood stem cell transplant]. / Suivi par IRM pelvi-rachidienne d'une cohorte de patients atteints de myélome multiple, traités par chimiothérapie à haute dose et autogreffe de cellules souches périphériques.

PURPOSE: To evaluate the changes of bone marrow lesions on pelvic and spinal MR in patients with multiple myeloma after high-dose chemotherapy and autologous peripheral blood stem cell transplant. PATIENTS AND METHODS: Pelvic and spinal MR examinations were obtained at presentation (myeloma diagnosis) and 1 year after transplant in 20 patients that were part of a group of 39 patients enrolled in a prospective study. The type of marrow replacement (classified in stages with stage 0: normal; stage 1: salt and pepper; stage 2: focal infiltration; stage 3: diffuse infiltration), the number and size of marrow lesions and the number of vertebral compression fractures were recorded. We have compared the findings prior to and following transplant, with correlation to the response to treatment and the use of biphosphonates. RESULTS: The type of marrow replacement was improved following transplant in 65% of patients (not statistically significant). The number and size of nodules > 20 mm showed significant reduction (p = 0.0224 and p = 0.0237 respectively). Lesions on MR improved in 50% of patients with good response and 75% of patients with poor response to treatment. Patients receiving biphosphonates showed more vertebral compression fractures. CONCLUSION: The evolution of marrow replacing lesions on MR is discordant compared to the biological and clinical response to treatment. Pelvic and spinal MR evaluation at the time of diagnosis does not appear to be a good predictive factor of response to treatment. Biphosphonates do not appear to prevent new vertebral compression fractures. Pelvic and spinal MR provides interesting data in the follow-up of patients with myeloma following autologous transplant, especially in the local evolution of marrow replacing lesions, but our results do not justify its use in routine clinical practice.

[High resolution MR imaging of the skin: normal imaging features]. / IRM haute résolution de la peau: aspects normaux.

PURPOSE: To describe the qualitative and quantitative MR imaging features of normal skin. MATERIALS AND METHODS: Thirty-one normal subjects underwent MR evaluation on a 1.5 Tesla magnet using a dedicated coil. Several skin sites were evaluated (back at the scapular level, posterior calf and inferior heel). Two pulse sequences were acquired: a SE T1W and a gradient-echo sequence (FIESTA). Qualitative and quantitative analysis was performed for all three sites. RESULTS: In normal subjects, the different skin layers (callus, epidermis, dermis, hypodermis and pilosebaceous follicles) can be separated and measured on MR. Epidermis and hypodermis are hyperintense whereas dermis is hypointense. Our results confirm the presence of qualitative and quantitative variations between different skin regions. In some cases, a differentiation between papillary and reticular dermis can be achieved. Pilosebaceous follicles and the deep vascular network were clearly depicted on the FIESTA sequence. Measurements for each skin layer were compared based on sex, site and MR pulse sequence. CONCLUSION: MRI provides evaluation of the different skin layers, epidermis, dermis, and hypodermis, and their different components.

[Shoulder radiography: useful radiographic views in current practice]. / Radiographies de l'épaule: les incidences utiles en pratique courante.

The purposes of this paper are: 1) to review the different radiographic projections commonly used to explore shoulder pathology; 2) to propose a practical approach for radiographic evaluation of the shoulder, adapted to the main clinical situations; 3) to recognize the different imaging features of the most frequent shoulder diseases.

Scleromyxoedema with associated peripheral neuropathy: successful treatment with thalidomide.

We report a patient with scleromyxoedema and peripheral neuropathy treated successfully with thalidomide. An objective evaluation was carried out using histopathology, cutaneous ultrasonography and magnetic resonance imaging (MRI). A 67-year-old woman presented with a leonine face, generalized thickened skin, an underlying peripheral neuropathy and a monoclonal gammopathy. She was treated with thalidomide 100 mg/day. After 20 months of therapy, there was a dramatic clinical improvement in the skin lesions, and the neuropathy also improved. Cutaneous ultrasonography showed a reduction in dermal thickness, whereas the results of the cutaneous MRI were inconclusive. Thalidomide appears to be effective in scleromyxoedema. Its specific effect on the underlying monoclonal gammopathy might have contributed to the improvement in the skin and neurological symptoms. In this case, assessment of cutaneous improvement with cutaneous ultrasonography was superior to that of cutaneous MRI. Thalidomide should be considered for the treatment of scleromyxoedema despite the presence of an underlying peripheral neuropathy.

[Shoulder pain: image guided management]. / Douleur de l'épaule: apport de la radiologie interventionnelle.

Different interventional radiology techniques used in the management of the painful shoulder will be reviewed in this article. The etiology of shoulder pain is variable, and several image guided procedures are available, from simple to more complex. US and fluoroscopy guided intra-articular and bursal infiltration techniques will be described. Percutaneous needle removal of calcific deposits and capsular distension/infiltration of adhesive capsulitis will be discussed. Cysts in the spinoglenoid or suprascapular notch may cause impingement of the suprascapular nerve and may be aspirated under US guidance. Finally, percutaneous radio-frequency treatment of symptomatic bone metastases under CT guidance may at times be performed. Musculoskeletal radiologists should be familiar with this spectrum of image guided interventional procedures.

[Spontaneous pneumomediastinum in dermatomyositis: a pathophysiological approach using imaging]. / Pneumomédiastin spontané et dermatomyosite: approche physiopathologique par l'imagerie.

INTRODUCTION: Spontaneous pneumomediastinum is a rare complication of dermatomyositis. CASE REPORT: We report a case of pneumomediastinum with massive subcutaneous emphysema occurring in a female patient with dermatomyositis treated with cortico-steroids. CONCLUSIONS: Our case illustrates perfectly the mechanism of spread of air along the broncho-vascular structures and also explains the presence of pneumomediastinum in the absence of pneumothorax.